Network analysis of anxiety and related factors in preschool children with autism spectrum disorder.

Purpose

Anxiety is a common comorbid condition in children with autism spectrum disorder (ASD), with a significantly higher prevalence than in neurotypical children, and is associated with adverse developmental outcomes. Previous research has linked intolerance of uncertainty (IU), sensory over-responsivity (SOR), and restricted and repetitive behaviors (RRBs) to anxiety, but their specific associations in preschool children with ASD remain unclear. This study explored the nature of anxiety and its connections with related factors using a network analysis approach.

Methods

This cross-sectional questionnaire study included 660 preschool children (288 with ASD and 372 neurotypical children). Standardized instruments assessed anxiety, IU, SOR, and RRBs. Gaussian graphical models were estimated using the GLASSO approach in R. Expected influence and bridge expected influence were calculated to identify the central and bridge nodes; network differences between groups were examined.

Results

(1) Worry about separation (A10); sweating or breathing difficulty (A7); avoidance of transportation (A15); and avoidance of darkness, crowds, heights, storms, or water (A17) were central nodes in the ASD anxiety symptom network. (2) IU, rigidity/adherence to routine, and SOR were bridge nodes in ASD anxiety and related factor networks. (3) ASD and neurotypical groups differed in network structure across networks, but only the anxiety symptom network differed in global strength. A15 and IU differed in expected influence and bridge expected influence, respectively.

Conclusion

These findings provide insight into anxiety symptoms and related factors in preschool children with ASD and may inform our understanding of anxiety and support for this population.